Association of Dysbiotic Vaginal Flora with Oncogenic Human Papillomavirus Infection, Bacterial Vaginosis and Pap Smear Abnormalities: Indian Context

Purpose Bacterial vaginosis (BV) is reported to be the most common cause of dysbiotic vaginal flora with frequent relapses among women. It increases the susceptibility to other genital infections resulting in cervicitis. Cervicitis can potentially modulate the progression of the oncogenic Human Papilloma virus infection. The current study addresses the gaps in literature regarding the prevalence and association of HPV, co-burden of HPV with BV infection among women with cervicitis in Indian context. Methods Totally, 508 eligible women, 254 with cervicitis (case arm) and 254 asymptomatic women with healthy cervix (control arm), attending a tertiary cancer hospital for cervical cancer screening were enrolled in the study. All enrolled women, irrespective of the study arm underwent Gram-stained smears for diagnosing Bacterial Vaginosis (BV), Hybrid Capture-2 test to diagnose oncogenic Human Papilloma Virus infection (HPV) and Pap smears to demonstrate epithelial cell abnormalities (ECA). Results The odds ratio of having BV infection (OR 18, 95% CI 9.62–36.99), ECA (OR 4.1, 95% CI 2.21–8.29) and HPV infection (OR 2.8, 95% CI 2.71–3.14) among women in case arm were significantly higher as compared to the control arm. Women in the case arm were also at significantly increased risk of co-infections of HPV with BV (OR 1.6, 95% CI 1.42–1.52). Conclusion Strong association of BV and HPV infection with increased ECA demonstrated in our study warrants prompt and effective treatment of BV. Genital infections are known modulators of persistent HPV infection. More longitudinal studies may lend better understanding of vaginal microbiome and its interplay between BV and HPV infections.